Lateral Acromioplasty has a Positive Impact on Rotator Cuff Repair in Patients with a Critical Shoulder Angle Greater than 35 Degrees

Edoardo Franceschetti; Edoardo Giovannetti de Sanctis; Alessio Palumbo; Riccardo Ranieri; Paola Casti; Arianna Mencattini; Nicola Maffulli; Francesco Franceschi

doi:10.3390/jcm9123950

Lateral Acromioplasty has a Positive Impact on Rotator Cuff Repair in Patients with a Critical Shoulder Angle Greater than 35 Degrees

J Clin Med. 2020 Dec 5;9(12):3950. doi: 10.3390/jcm9123950.

Authors

Edoardo Franceschetti¹, Edoardo Giovannetti de Sanctis², Alessio Palumbo¹, Riccardo Ranieri³, Paola Casti⁴, Arianna Mencattini⁴, Nicola Maffulli^{5

6

7}, Francesco Franceschi⁸

Affiliations

¹ Department of Orthopaedic and Trauma Surgery, Campus Biomedico University of Rome, Via Alvaro del Portillo 200, 00128 Rome, Italy.
² Department of Orthopaedics and Traumatology, Catholic University, Agostino Gemelli Hospital, 00168 Rome, Italy.
³ Department of Orthopaedic and Trauma Surgery, Humanitas Clinical and Research Center, Rozzano, 20089 Milan, Italy.
⁴ Department of Electronics Engineering, University of Rome Tor Vergata, Via del Politecnico 1, 00133 Rome, Italy.
⁵ Department of Musculoskeletal Disorders, Via Salvador Allende, 43, 84081 Baronissi, Italy.
⁶ Centre for Sports and Exercise Medicine, Barts and The London School of Medicine and Dentistry, Mile End Hospital, 275 Bancroft Road, London E1 4DG, UK.
⁷ School of Pharmacy and Bioengineering, Keele University School of Medicine, Thornburrow Drive, Stoke on Trent ST4, UK.
⁸ Department of Orthopaedic and Trauma Surgery, San Pietro Fatebenefratelli Hospital, Via Cassia 600, 00123 Rome, Italy.

Abstract

Background: A Critical Shoulder Angle (CSA), evaluated on plain radiographs, greater than 35° is considered predictive of rotator cuff tears. The present prospective comparative study aimed, firstly, to develop a formula to calculate the amount of acromion that should be resected performing a lateral acromioplasty and, secondly, verify whether lateral acromioplasty to reduce the CSA associated with arthroscopic cuff repair decreased the rate of recurrence of the tears, and impacted favorably on clinical postoperative outcomes.

Methods: Patients undergoing arthroscopic rotator cuff repair (RCR) for rotator cuff tears with a CSA greater than 35° were included in this study and divided into two groups, based on whether the CSA had been reduced by arthroscopic resection of the lateral portion of the acromion. A new mathematical formula was developed in order to quantify the amount of bone to be resected while performing the lateral acromioplasty. Patients with traumatic tears, previous surgery, osteoarthritis or plain radiographs, not classified as A1 according to Suter-Henninger, were excluded. Clinical and radiographic outcomes were assessed at a minimum of 2 years of follow-up considering the tear size.

Results: 289 patients were included in this study. Thirty-seven were lost to follow-up. Group A (Lateral acromioplasty) patients included: 38 small tears, 30 medium tears, 28 large tears and 22 massive tears; Group B (control group) was composed of 40 small tears, 30 medium tears, 30 large tears and 23 massive tears. The Constants Score value and retear Rate were, respectively, significant higher (p = 0.007 and p = 0.004) and lower (p = 0.029 and p = 0.028) in Group A, both in the Small-and Medium-size subgroups. No complications were outlined. The mediolateral width of the acromion was reduced, according to the preoperatively calculated measure.

Conclusion: Arthroscopic lateral acromioplasty decreased the CSA within the favorable range (30°-35°) in all patients treated, resecting the amount of bone predicted by the mathematical formula. Lateral acromioplasty is a safe and reproducible technique which may prevent recurrence of rotator cuff tears in patients with small and medium lesions.

Level of evidence: II.

Keywords: critical shoulder angle; rotator cuff tear; shoulder; shoulder arthroscopy.